| NPI | 1508861865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-412) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001125) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2012-08-29 |